title: Routine spinal navigation for thoraco-lumbar pedicle screw insertion using the O-arm three-dimensional imaging system improves placement accuracy.
abstract: Modern image-guided spinal navigation employs high-quality intra-operative three dimensional (3D) images to improve the accuracy of spinal surgery. This study aimed to assess the accuracy of thoraco-lumbar pedicle screw insertion using the O-arm (Breakaway Imaging, LLC, Littleton, MA, USA) 3D imaging system. Ninety-two patients underwent insertion of thoraco-lumbar pedicle screws guided by O-arm navigation over a 27 month period. Intra-operative scans were retrospectively reviewed for pedicle breach. The operative time of patients where O-arm navigation was used was compared to a matched control group where fluoroscopy was used. A total of 467 pedicle screws were inserted. Four hundred and forty-five screws (95.3%) were placed within the pedicle without any breach (Gertzbein classification grade 0). Sixteen screws (3.4%) had a pedicle breach of less than 2mm (Gertzbein classification grade 1), and six screws (1.3%) had a pedicle breach between 2mm and 4mm (Gertzbein classification grade 2). The grade 2 screws were revised intra-operatively. There was no incidence of neurovascular injury in this series of patients. The mean operative time for O-arm patients was 5.25 hours. In a matched control group of fluoroscopy patients, the mean operative time was 4.75 hours. The difference in the mean operative time between the two groups was not statistically significant (p=0.15, paired t-test). Stereotactic navigation based on intra-operative O-arm 3D imaging resulted in high accuracy in thoraco-lumbar pedicle screw insertion.
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore 11 Jalan Tan Tock Seng, Sinagpore 308433, Singapore.
authors.forename: Ji Min
authors.initials: JM
authors.lastname: Ling
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore 11 Jalan Tan Tock Seng, Sinagpore 308433, Singapore.
authors.forename: Shree Kumar
authors.initials: SK
authors.lastname: Dinesh
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore 11 Jalan Tan Tock Seng, Sinagpore 308433, Singapore.
authors.forename: Boon Chuan
authors.initials: BC
authors.lastname: Pang
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore 11 Jalan Tan Tock Seng, Sinagpore 308433, Singapore.
authors.forename: Min Wei
authors.initials: MW
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore 11 Jalan Tan Tock Seng, Sinagpore 308433, Singapore.
authors.forename: Heng Lip
authors.initials: HL
authors.lastname: Lim
authors.affiliation: Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Danny T
authors.initials: DT
authors.lastname: Louange
authors.affiliation: Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Chun Sing
authors.initials: CS
authors.lastname: Yu
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore 11 Jalan Tan Tock Seng, Sinagpore 308433, Singapore. Electronic address: ernest@wangsonly.com.
authors.forename: Chee Meng Ernest
authors.initials: CM
authors.lastname: Wang
mesh_terms: D001863:Bone Screws; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D038361:Neuronavigation / Q000379:methods*; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*
keywords: Navigation; O-arm; Pedicle screw; Stereotaxy